<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket>
<wicket:panel>

    <form wicket:id="innerForm" class="form-horizontal">
        <div class="row-fluid">
            <div class="control-group">
                <label class="control-label">Huisarts</label>
                <div class="controls">
                    <input class="input" type="text" wicket:id="achternaam">
                </div>
            </div>
            <div class="control-group">
                <label class="control-label">AGB-code</label>
                <div class="controls">
                    <input class="input" type="text" wicket:id="agbcode">
                </div>
            </div>
            <div class="control-group">
                <label class="control-label">Locatie</label>
                <div class="controls">
                    <input class="input" type="text" wicket:id="locatieNaam">
                </div>
            </div>
            <wicket:container wicket:id="adresZoekvelden">
                <div class="control-group">
                    <label class="control-label">Straatnaam</label>
                    <div class="controls">
                        <input class="input" type="text" wicket:id="straat">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Postcode</label>
                    <div class="controls">
                        <input class="input" type="text" wicket:id="postcode">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Plaats</label>
                    <div class="controls">
                        <input class="input" type="text" wicket:id="plaats">
                    </div>
                </div>
            </wicket:container>
        </div>
    </form>

    <div class="row-fluid show-results">
        <div wicket:id="huisartsLocaties"/>
    </div>
</wicket:panel>
</html>
